Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Department of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, ON, Canada.
J Otolaryngol Head Neck Surg. 2019 Aug 29;48(1):41. doi: 10.1186/s40463-019-0366-3.
Conservative management of Warthin tumor (WT) may be a viable alternative to surgery, but there are concerns of missed malignancies on fine needle aspiration biopsy (FNAB). The purpose of this study is to measure the sensitivity and positive predictive value of FNAB for WT, and to identify clinical features associated with WT that can aid in this diagnosis.
Retrospective analysis of patients from January 1, 2006 to April 30, 2017 at a tertiary care center in London, Ontario, Canada. All patients with a diagnosis of WT on FNAB or resection were included. Electronic medical records were identified for 177 patients that fit the criteria. Study outcomes included the sensitivity and positive predictive value of FNAB alone for WT, and, when including clinical features associated with WT.
The mean age of patients in this study was 63.2 years (SD 10.4); 115 (65%) were male, and 157 (89%) were past or present smokers. The measured sensitivity and positive predictive value of FNAB for WT were 95.8 and 97.2% respectively. Two cases were classified as WT on FNAB but confirmed at resection as mucoepidermoid carcinoma and acinic cell carcinoma. When only patients with multifocal, bilateral or incidental tumors were assessed, sensitivities and positive predictive values for each were 100%. Isolating for inferior pole location also resulted in a positive predictive value of 100%.
The sensitivity and positive predictive value of FNAB for WT in this study are high, with two false negatives on FNAB. Multifocal, bilateral, incidentaloma and inferior pole location were identified as potential clinical features that may increase the diagnostic confidence for WT, strengthening the argument for conservative management in these patients. Overall, this study serves as an initial exploration into whether clinical features may be included with FNAB results to improve the sensitivity and positive predictive value of diagnosing WT. Further research is necessary before these findings can be translated into clinical practice.
Warthin 肿瘤（WT）的保守治疗可能是手术的可行替代方案，但细针抽吸活检（FNAB）可能会漏诊恶性肿瘤。本研究旨在测量 FNAB 对 WT 的敏感性和阳性预测值，并确定与 WT 相关的有助于诊断的临床特征。
对 2006 年 1 月 1 日至 2017 年 4 月 30 日期间在加拿大安大略省伦敦的一家三级保健中心就诊的患者进行回顾性分析。所有在 FNAB 或切除时诊断为 WT 的患者均纳入研究。确定了符合标准的 177 名患者的电子病历。研究结果包括 FNAB 单独用于 WT 的敏感性和阳性预测值，以及包括与 WT 相关的临床特征时的敏感性和阳性预测值。
本研究中患者的平均年龄为 63.2 岁（标准差 10.4）；115 名（65%）为男性，157 名（89%）为既往或现在吸烟者。FNAB 对 WT 的测量敏感性和阳性预测值分别为 95.8%和 97.2%。有 2 例 FNAB 诊断为 WT，但在切除时被诊断为黏液表皮样癌和涎腺型嗜酸细胞癌。当仅评估多灶性、双侧或偶然肿瘤的患者时，每种肿瘤的敏感性和阳性预测值均为 100%。孤立性下极肿瘤也导致阳性预测值为 100%。
本研究中 FNAB 对 WT 的敏感性和阳性预测值均较高，FNAB 有 2 例假阴性。多灶性、双侧、偶发肿瘤和下极肿瘤被确定为可能增加 WT 诊断信心的潜在临床特征，从而支持对这些患者进行保守治疗。总的来说，本研究初步探讨了临床特征是否可以与 FNAB 结果结合使用，以提高诊断 WT 的敏感性和阳性预测值。在这些发现能够转化为临床实践之前，还需要进一步的研究。
